NiCole R. Keith

Intravenous versus oral rehydration during a brief period : responses to subsequent exercise in the heat

PURPOSE The purpose of this study was to assess whether a brief period (20 min) of intravenous (i.v.) fluid rehydration versus oral rehydration differentially affects cardiovascular, thermoregulatory, and performance factors during exhaustive exercise in the heat. METHODS Following dehydration (-4% of body weight), eight nonacclimated highly trained cyclists (age = 23.5 +/- 1.2 yr; VO2peak = 61.4 +/- 0.8 mL x kg x min(-1); body fat = 13.5 +/- 0.6%) rehydrated and then cycled at 70% VO2peak to exhaustion in 37 degrees C. Rehydration (randomized, cross-over design) included: 1) CONTROL (no fluid), 2) DRINK (oral rehydration, 0.45% NaCl) equal to 50% of prior dehydration, and 3) IV (intravenous rehydration, 0.45% NaCl), equal to 50% of prior dehydration. Thus, in the DRINK and IV treatments subjects began exercise (EX) at -2% of body weight. RESULTS Exercise time to exhaustion was not different (P = 0.07) between DRINK (34.9 +/- 4 min) and IV (29.5 +/- 3.5 min), but both were significantly (P < 0.05) longer than CONTROL (18.9 +/- 2.7 min). Plasma volume was better (P < 0.05) restored during IV than CONTROL and DRINK at pre-exercise and 5 min EX, but different (P < 0.05) from only CONTROL at 15 min EX. Plasma lactate during DRINK was lower (P < 0.05) than IV at 15 min EX and postexercise. Heart rate during CONTROL was greater (P < 0.05) than DRINK and IV from 0-8 min EX, and greater (P < 0.05) than DRINK from 10-14 min EX. Rectal temperature during DRINK was less (P < 0.05) than IV from 0-24 min EX. Mean weighted skin temperature during DRINK was less (P < 0.05) than IV from 4-12 min EX. CONCLUSIONS Thus, despite no statistically significant performance differences between DRINK and IV, it appears that certain physiological parameters were better maintained in the DRINK trial, and the trend toward performance differences may be important to elite athletes.

A systematic review of physical activity interventions among African American adults: evidence from 2009 to 2013

This review extends findings from four previous reviews of physical activity (PA) interventions among African Americans (AA) and includes papers published between January 2009 and August 2013. Eligible papers were retrieved using strategies employed in previous reviews. Overall, 16 relevant papers were identified, including four pilot studies and 12 full trials. Interventions were based on a variety of behavioural sciences theories. The most common setting for interventions was churches. Most interventions lasted >6 months; few interventions included >6 months of post‐intervention follow‐up. Overall, studies identified within‐group differences showing positive improvements in PA, and most studies showed statistically significant between‐group differences in at least one measure of PA. A quality score was used to rate various elements of the studies and provide a numerical assessment of each paper; scores ranged from 3 to 10 out of 13 possible points. The current review indicates a continued need for studies that use objective PA measures, assess long‐term intervention impact, provide specific PA goals for interventions, include more attention to strategies that can increase retention and adherence among AA study participants, include AA men and determine the independent and synergistic effects of individual and environmental (socio‐cultural and built) change strategies.

Screening, Referral, and Participation in a Weight Management Program Implemented in Five CHCs

Community health centers have the potential to lessen obesity. We conducted a retrospective evaluation of a quality improvement program that included electronic body mass index (BMI) screening with provider referral to an in-clinic lifestyle behavior change counselor with weekly nutrition and exercise classes. There were 26,661 adult patients seen across five community health centers operating the weight management program. There were 23,593 (88%) adult patients screened, and 12,487 (53%) of these patients were overweight or obese (BMI ≥25). Forty percent received a provider referral, 15.6% had program contact, and 2.1% had more than 10 program contacts. A mean weight loss of seven pounds was observed among those patients with more than 10 program contacts. No significant weight change was observed in patients with less contact. Achieving public health impact from guideline recommended approaches to CHC-based weight management will require considerable improvement in patient and provider participation.

The Active Living Research 2013 Conference: Achieving Change Across Sectors: Integrating Research, Policy, and Practice

Achieving Change Across Sectors: Integrating Research, Policy, and Practice (C. D. Economos) The 2013 Active Living Research (ALR) Annual Conference brought together a network of individuals from research, policy, and practice to exchange data, experiences, and aspirations toward building a more active-friendly national landscape. There were evidence generators, evidence users, and those who do a bit of both. Primarily a generator, I also find myself at the intersection when called upon to inform policy or to implement evidence-based practice. My own approach to research has become more interdisciplinary and participatory to generate evidence that is inclusive and relevant to policy debates, so the conference theme created a comfortable atmosphere for me. The rich dialogue among attendees exemplified the commitment of many to uphold our individual roles, varied at times throughout our careers, in designing and implementing evidence-based public health strategies and policies to promote effective and sustained action. What becomes exceedingly clear when sectors are brought together is that the system is interdependent—evidence informs policy development and practice, and evaluating policy implementation and practice-based interventions generates new evidence. The cycle is continuous. Public health has several health priorities that require thoughtful and careful collaborations between researchers, practitioners, and policymakers across many sectors. Perhaps most pressing is the fact that we have an obesity epidemic caused by environments and policies that encourage overconsuming and underexpending energy. The urgency of addressing the epidemic compels a variety of policy-related actions that reach far and deep within the population. To maximize impact, these actions must be feasible, synergistic, cost-effective, free of unintended adverse consequences, and based on the best available evidence. From the perspective of an evidence generator, the following questions are contemplated on a regular basis: What is the status of the evidence? How do we go forward in the absence of complete evidence? What types of studies are required to fill the gaps and expand the evidence base? What are the disciplines that would enrich a research study? Who should participate in the research process? How do we communicate useful results to people who can use them? From the perspective of a policymaker or practitioner (or evidence user), the questions begin once a body of evidence exists: How can the data be combined and compiled to inform decision makers and stakeholders about the value and importance of evidence and how it could inform a particular policy decision? What type of methods should be used to evaluate the impact of new policy implementation? To address these questions and others, the Institute of Medicine’s Bridging the Evidence Gap report explains how various forms of evidence are used in evidence-based public health decision making. A closer look at the types of evidence and how it’s used in policymaking illustrates the range of information often taken into account by policymakers and suggests an expanded role for evidence generators. For example, when conducting a controlled trial in a community with multilevel outcomes, it is important to pay attention to the knowledge, ideas and interests, and opinions and views of the community as well as costs and resources used. A variety of distinct pieces of evidence (quantitative and qualitative) and sources of knowledge have meaning and can ultimately inform policy. This generally makes the results more meaningful for the community and their representatives. Different types of evidence can be merged with specific capacities, such as an individual’s skills, experience, and participation in networks, to influence the adoption and adaptation of evidence in practice. At the organizational levels, capacity is often visible leadership, Christina D. Economos, PhD, is at Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts. James F. Sallis, PhD, is with Active Living Research, University of California, San Diego, San Diego, California. NiCole R. Keith, PhD, is at the Department of Kinesiology, Indiana UniversityPurdue University, Indianapolis, Indiana. Jimmy Newkirk, BS, is with the National Physical Activity Society, Coats, North Carolina.

Achieving Equity in Physical Activity Participation: ACSM Experience and Next Steps

ABSTRACT There is clear and consistent evidence that regular physical activity is an important component of healthy lifestyles and fundamental to promoting health and preventing disease. Despite the known benefits of physical activity participation, many people in the United States remain inactive. More specifically, physical activity behavior is socially patterned with lower participation rates among women; racial/ethnic minorities; sexual minority youth; individuals with less education; persons with physical, mental, and cognitive disabilities; individuals >65 yr of age; and those living in the southeast region of the United States. Many health-related outcomes follow a pattern that is similar to physical activity participation. In response to the problem of inequities in physical activity and overall health in the United States, the American College of Sports Medicine (ACSM) has developed a national roadmap that supports achieving health equity through a physically active lifestyle. The actionable, integrated pathways that provide the foundation of ACSM’s roadmap include the following: 1) communication—raising awareness of the issue and magnitude of health inequities and conveying the power of physical activity in promoting health equity; 2) education—developing educational resources to improve cultural competency for health care providers and fitness professionals as well as developing new community-based programs for lay health workers; 3) collaboration—building partnerships and programs that integrate existing infrastructures and leverage institutional knowledge, reach, and voices of public, private, and community organizations; and 4) evaluation—ensuring that ACSM attains measurable progress in reducing physical activity disparities to promote health equity. This article provides a conceptual overview of these four pathways of ACSM’s roadmap, an understanding of the challenges and advantages of implementing these components, and the organizational and economic benefits of achieving health equity.

Sex and Race Differences in the Relationship between Obesity and C-Reactive Protein

C-reactive protein (CRP) is a risk factor for cardiovascular disease and mortality; it is known to be positively associated with obesity but there is some evidence that this association differs by race or sex. We used nationally representative data of adults aged >50 years to investigate sex and race modifiers of the associations between obesity and CRP in non-Hispanic White males (n=3,517) and females (n=4,658), and non-Hispanic Black males (n=464) and females (n=826). Using multiple linear regression models with the natural logarithm of CRP as the dependent variable, we sequentially included body mass index (BMI), a body shape index (ABSI), and socioeconomic, health and health behavior covariates in the model. The association between BMI and CRP was significantly stronger in females than males. Obese White females had mean CRP values slightly above 3 mg/liter (vs 2 for White males) and Black females had mean CRP values >4 mg/liter (vs 3 for Black males). More than 50% of Black females in the United States have obesity. Continued research into racial and sex differences in the relationship between obesity, inflammation, and health risks may ultimately lead to more personalized weight loss recommendations.

Design and Reach of a Primary Care Weight Management Program

Purpose. To report the reach of Take Charge Lite (TCL), a lifestyle weight management program. Methods. Eight months of data were used to determine prescription reach (number of patients receiving a TCL prescription divided by total eligible), visit reach (number of patients with a TCL visit divided by total receiving a prescription), and total reach (number of patients with a TCL visit divided by total eligible). Results. TCL prescription reach was 42.3% (1,071 prescriptions/2,528 eligible). There were 411 TCL first visits for an average visit reach of 38% (411/1,071). Total reach for the full period was 16% (411/2,528). Total reach was highest among female, middle-aged, and Black patients. Conclusion. There is potential for public health impact from such efforts but issues of reach require further planning and evaluation.

Experiential Learning in Kinesiology: A Student Perspective.

Overview. Service learning is a form of experiential learning that pairs academic educational experiences and community organizations to promote training, civic engagement, and meaningful service by students to their community. Kinesiology programs have moved toward increasing experiential and service learning options in health promotion for their students, but few have evaluated the student perceptions of these programs. Purpose. The purpose of the current study was to conduct a qualitative evaluation of a service learning course for kinesiology majors located in a low-income urban area. Method. Ten recent graduates of a department of kinesiology were enrolled in focus groups, stratified by gender, facilitated by a graduate research assistant not affiliated with their school. Focus group discussions were audiotaped, transcribed, and analyzed for themes. Results. Nine themes were identified: (1) personal and professional experience, (2) decision to participate, (3) location decision, (4) self-efficacy, (5) perceptions of program members, (6) social interaction, (7) personal and program communication, (8) physical facilities, and (9) program outcomes. Students positively evaluated the learning experience as valuable to their personal and professional development; noted changes in their perceptions of low-income communities and increases to self-efficacy and skill acquisition from the beginning to the end of the course; and observed significant needs and improvements in physical, emotional, and social outcomes of community members. Conclusions. This study demonstrated multiple and varied benefits of a service learning program for kinesiology students. Ongoing evaluation of service learning programs in health promotion is needed to enhance student and community outcomes.

Identifying Contextual and Emotional Factors to Explore Weight Disparities between Obese Black and White Women

BACKGROUND Obese black women enrolled in weight loss interventions experience 50% less weight reduction than obese white women. This suggests that current weight loss strategies may increase health disparities. OBJECTIVE We evaluated the feasibility of identifying daily contextual factors that may influence obesity. METHODS In-home interviews with 16 obese (body mass index ≥ 30) black and white urban poor women were performed. For 14 days, ecological momentary assessment (EMA) was used to capture emotion and social interactions every other day, and day reconstruction method surveys were used the following day to reconstruct the context of the prior day’s EMA. RESULTS Factors included percentage of participants without weight scales (43.8%) or fitness equipment (68.8%) in the home and exposed to food at work (55.6%). The most frequently reported location, activity, and emotion were home (19.4 ± 8.53), working (7.1 ± 8.80), and happy (6.9 ± 10.03), respectively. CONCLUSION Identifying individual contexts may lead to valuable insights about obesogenic behaviors and new interventions to improve weight management.

The 2016 Active Living Research Conference: Equity in active living

For over a decade, Active Living Research (ALR) has supported the generation, compilation, and dissemination of interdisciplinary evidence that active living is important to the Earth and its residents. Simultaneously, ALR-affiliated researchers and practitioners recognize that the opportunity to be active within a community is influenced by personal, social, environmental, and policy-related factors (Lee and Cubbin, 2009; Ding et al., 2011). TheALRmeeting has served as a consistent forum where physical activity, built environment, and policy professionals can share both ideas and outcomes. From the beginning, ALR as an organization, its grant awardees, and meeting attendees have been focused on the importance of addressing health equity through our work (Sallis et al., 2009). Recognition that certain groups have less access to opportunities and environments supportive of physical activity and are especially vulnerable to policies that prevent physical activity, has fueled these efforts. The 2016 ALR Conference theme, Equity in Active Living, was developed in response to ongoing concerns and growing evidence about inequity of opportunity to be active. This meeting offered research and practice presentations that built evidence for ways to enhance equity of active living among diverse groups, who are most at-risk of physical inactivity. Achieving equity in active living is not a simple task. People tend to be most comfortable in homogeneous groups where there is trust and social cohesion. These constructs tend to go down in diverse groups (Phillips and Lount, 2007). However, diverse groups perform better both intellectually and economically. Themost successful societies, systems and organizations intentionally build diversity in order to address equity (Laurence, 2009). ALRs strategic and deliberate focus on building a large interdisciplinary group of experts who are not only attentive to equity but are also diverse both professionally and demographically (Sallis et al., 2005) may explain why the organization itself has performed so well and why the ALR meetings continue to thrive. ALRaffiliated experts have demonstrated that physical activity is determined by the built environment and by socio-economic context through the employment of policies and the application of social and behavioral models and theory-based interventions that have resulted in healthier communities (Sallis et al., 2006). Creating equity in active living will aid in addressing both economic and health disparities. At the 2016 ALR meeting, the Program Chairs opening remarks differentiated between equality and equity. Equality promotes sameness by insuring that all people have the same access and resources (Morgan and Sawyer, 1979). Creating equal communities